Effects of Landiolol, an Ultra-Short-Acting .BETA.1-Selective Blocker, on Electrical Storm Refractory to Class III Antiarrhythmic Drugs

Abstract

Background:Occasionally it is difficult to inhibit electrical storm (ES) with standard pharmacological treatment. In the present study the effect of landiolol, an ultra-short-acting β1-selective blocker, on ES refractory to class III antiarrhythmic drugs was evaluated. Methods and Results:The study group comprised 42 consecutive patients who developed ES for which intravenous class III antiarrhythmic drugs, such as amiodarone and nifekalant, were ineffective. Landiolol was administered intravenously with an initial dose of 2.5 μg · kg -1 · min -1 , which was doubled if it was ineffective, up to a maximum dose of 80 μg · kg -1 · min -1 . Landiolol inhibited ES in 33 patients (79%) at a mean dose of 7.5±12.2 μg · kg -1 · min -1 . All patients in whom landiolol was ineffective died of arrhythmia. Of the 33 patients in whom landiolol was effective, 25 survived and were discharged (60% of all patients). Landiolol significantly decreased heart rate (P<0.0001), but did not affect blood pressure. Landiolol was not discontinued for adverse effects in any of the responders. Age, APACHE II score, and pH of arterial blood gas differed significantly between the responders and nonresponders. Conclusions:Landiolol is useful as a life-saving drug for class III antiarrhythmic drug-resistant ES. The main mechanism of ES refractory to class III antiarrhythmic drugs could be abnormal automaticity but not reentry. (Circ J 2010; 74: 856 - 863)

Simultaneous Assessment of T-Wave Alternans and Heart Rate Turbulence on Holter Electrocardiograms as Predictors for Serious Cardiac Events in Patients After Myocardial Infarction

“…Many studies have shown that antiarrhythmic drug and β-blocker therapies at the acute phase of MI affect prognosis in patients with MI. 24 Similarly, we do not know the effect of these drugs in this study.…”

First Report of Survival in Refractory Ventricular Fibrillation After Dual-Axis De brillation and Esmolol Administration

“…In the setting of cardiac arrest, the patient not only has a swell of endogenous catecholamines, but is also receiving exogenous epinephrine every 3–5 minutes 6. Several studies report on survival with positive neurological outcome through the use of standard class III antiarrhythmics with subsequent administration of short-acting beta blockers 6–7, 11–12…”

Urgent Management of Rapid Heart Rate in Patients With Atrial Fibrillation/Flutter and Left Ventricular Dysfunction

“…11 Based on these properties, landiolol has been reported to be useful for treating several acute disorders, including arrhythmias during heart surgery, 12 acute myocardial infarction, 13 acute decompensated heart failure, 14 and refractory electrical storm. 15 Ultra-short-acting β-blockers may be useful to control the HR with minimal effects on cardiac function because the negative inotropic effect is not sustained after decreasing the dose or stopping administration of these drugs. Therefore, the present study was designed to evaluate the efficacy and safety of intravenous landiolol for achieving rapid control of tachycardia in patients with AF/AFL and LV dysfunction.…”